Organic Acid Testing Review – Uncover Your Metabolic Road Blocks
By Dr. Justin Marchegiani
Organic acids are made by your metabolism. They come from amino acids or proteins essentially. They can give us a window underneath the hood what’s happening with B vitamins, with methylation, with detox, with neurotransmitters, mitochondrial function, how you’re generating energy from proteins, fats, and carbohydrates, etc. Watch this video and learn more what are the five big root cause of organic acids.
Today’s video’s going to be on organic acid testing. We’re going to dive in deep to a patient’s lab. Also, we’re going to go over organic acids- how to look at them, testing-wise and what they actually mean from the inside out.
So off the bat, organic acids are made by your metabolism. They come from amino acids or proteins, essentially. They can give us a window deeper under the hood of what’s happening with B vitamins, with methylation, with detox, with neurotransmitters, mitochondrial function, how you’re generating energy from proteins, fats and carbohydrates, neurotransmitters, oxidative stress. It even can look on fungus and bacterial overgrowth. So it gives us a good window of what’s happening underneath the hood.
Now, we will look at tests. Actually look at the summary of abnormal findings and go through what everything means.
Why organic acids go out of balance?
- Poor diet
- Genetic (MTHFR)
This can be poor macronutrients, proteins, you’re on a low-fat diet, a very high amount of carbohydrates with insulin resistant or could be just poor quality of food. Lots of toxins, chemicals, inflammatory food as well. So make sure that your diet is on point.
This could be low stomach acid or enzymes. You could have infections infections like SIBO or bacteria or parasitic infections, and could even be food allergies as well. Including sensitivity followed by leaky gut, etc.
This could be emotional stress such as relationship, financial issues, family, friends issues, work issues. It can also be too much exercise, very high amount of physical exercise or even too little. And it also could be sleep – poor sleep. Sleep really helps recharge and reinvigorate you for the next day and repair also.
Toxins whether it’s from round up or pesticides, glyphosate, heavy metals and environmental stressors like mold or mycotoxins or even EMF.
There is an MTHFR, SNP issue or just need certain higher levels of other nutrients like magnesium or B6. Everyone’s a little bit different.
So now knowing that, let’s dig in. So off the bat, you can see this patient’s lab test a lot of things are popping up. Issue with fatty acids, issues with carbohydrate, energy. The big thing off the bat is amino acids,amino acids, amino acids. Carnitine’s actually made from methionine and lysine free-form aminos, tyrosine neurotransmitter issues.
Some issues with amino acids seen on lab tests
This means that neurotransmitters are more burnt out. And the big thing I’m seeing is stress and/or malabsorption. When you see amino acids like this go crazy off the chart, that’s definitely an issue – lower brain amino acids and obviously, gut issues.
In this patient, we have other lab tests in this patient but there’s infections present as well, which is setting up for that area number two which is the malabsorption issue. We’re seeing nutrients not quite present at optimal levels and just the pattern we’re seeing really tells us a strong malabsorption going on. Persons diet’s already good, pretty good. Malabsorption is definitely present and with that, stress definitely becomes an issue. Also, sleep and all that we are working on that with the adrenals in diet and lifestyle;but malabsorption is definitely present.
So let’s go look at the nitty-gritty of the lab testing here. We like the patient to be somewhere between the top part of the first and the bottom part of the fourth. This is what I call the sweet spot that we like right in the middle. This is like the field-goal post we want to kick the ball right through for that field goal. When organic acids go high or low, there’s essentially imbalances in those intervention or companion nutrients.
Demand or Depletion Issue
You can see the Carnitine for the Ethyl Manolate. You can see that Mandelate, the companion nutrients, Tyrosine. So if these organic acids go high or low, it means either a demand or depletion issue. So when organic acids go high, there’s a massive demand issue. That means the body needs that nutrient at a higher amount than what is present.
So my analogy to the patients and that’s like you’re making $1 million a year but you’re spending $2 million a year. You’re making a lot of money but you are spending too much. Your budget needs to get rained in. That’s the big five things we talked about earlier. And then on the depletion side of now your organic acids are low. That’s typically from chronic stress of those big five issues, more chronic longer-term issue. It’s like you’re making $1000 a year, but you’re spending 10,000. One, you’re not making that much to begin with. Number two, you’re spending way more than what you’re making, anyway. So it’s going to be impossible to get ahead.
So we have to work on getting to the big five of why that is the case. When you see organic acids high or low, they mean different things, but low is more depleted; high is more demand. They both mean that those intervention nutrients need to be supported and addressed. And obviously, the underlying big five stressors need to be looked at- which in this case, is definitely going to be malabsorption and stress.
Low Amino Acids
You can see this person here, a little bit high in the Ethyl Malonate, which we talked about – means Carnitine, we saw the L – lactate. So you can see if we draw a sweet spot here, we’re very low in this area. And that’s another marker for amino acids. So the amino acids are very low and you can see some of these are two-tailed, some are one. So if you were to do like a Beta Hydroxy Butyrate, well there’s no left area that’s low. But if you go down below, under energy production, there’s definitely red on the right and left of Citrate, Cis-Aconitate and Isocitrate.
So that means we have two-tailed here and only one tail below. That matters is that we have, let’s say Malate is low, that’s important to know. But it’s more important that if Isocitrate is low because it’s actually a red area. It’s two-tailed, there’s a high and a low versus just a high.
So on that note, we can see with the above that’s amino acids, lower amino acids. You can see the mitochondria. Here’s our sweet spot. If we only have two organic acids in the sweet spot, we definitely have these two were low, but these three above are more important because there is no red area to the left down there.
Low B Vitamins
But we can see the mitochondria and how we’re generating energy is severely depleted and again this one of this patient’s chief issues is fatigue and you can see five areas in the bad left area and you can see three are very low. So definitely a depleted mitochondria, for sure. B vitamins, nothing’s flagged high but you can see we’re definitely in the low area. We’re definitely in that first quintile, and if you go back here, you can see B complex vitamins are part of what’s needed to drive the citric acid, Krebs cycle, warrior mitochondria. Essentially all the same name here for this.
So B vitamins definitely in the lower side. Methylation, a little bit in the lower side. I get more concerned when these go higher with Methylmalonate goes higher, it means we’re depleting a lot of B-12. When B12 isn’t present, Methylmalonate goes high. So it’s definitely part of this sequelae of this low B vitamin symptomatology we’re seeing. Lower energy means lower B vitamins.
Neurotransmitters, you can see this person is low in Vanilmandelate, which means lower adrenaline. Lower adrenaline so their ability to regulate stress and adapt to stress is going to be thwarted and maybe some anxiety too, pretty possible or inability to focus When you have not enough adrenaline or dopamine, you typically lose that ability to focus longer and the time there. Homovanilate, 5-Hydroxyindoleacetate, that’s serotonin and dopamine, those are okay. Kyunurenate, it’s a little bit low. It’s a marker for B6, Quinolinate and Picolinate are markers for brain inflammation. Look okay but definitely the adrenaline markers are lower. Oxidative stress look pretty good. I’m fine with these being low because, you know, less oxidative stress, stress or internal rusting.
Detox, you can see, very much on the low side and again this didn’t even get flagged on the summary page of this. It’s important because if you’re just getting this test on your own, you’re like, “fine detox look no problems”- wrong. There is a massive polar shift to the left, which tells me there’s a severe depletion, remember. Lower organic acids depletion on the left section. Sulfate, the only one in the middle. This is sitting right on the fence of being low. Right on the fence being low gets flagged at 28. That’s 29- that’s a big marker for sulfur amino acids and glutathione precursors. So definitely an issue. They’re having a harder time to bring those nutrients on board to make the glutathione and to make all the phase 2 and phase 1, literally toxifying support.
And in gut bacteria, it’s got one that’s high down here and the one that’s borderline. Indican is on the higher side that means not quite digesting protein well. Inability to digest proteins in putrefaction happening and just higher amounts of bad bacteria. And as you can see here this is what gets flagged when it’s 5% in the top 5%-1.41 It gets into the red .73, 1.41 and reach the top 5% of the reference range. Top 5% in this patient here. 1.84. So we don’t just look at it when it’s high, that’s very high. A lot of gut bacteria dysbiosis and some putrefaction are happening, meaning not quite digesting protein. And that makes sense because when we go back to the protein on the summary page, a lot of amino acids were low and then yeast and fungus looked okay.
So if we go back here to the summary page, high and low organic acids mean something. We already talked about that. Depletion on the low-end demand in the high-end. The big five tend to be the driving factors why this go out of balance. Diet, malabsorption stress, sleep, toxicity and genetics. Genetics being MTHFR, and we’ll see that with high amounts of Methylmalonate and/or formiminoglutamate but again, this is a quick video just to give you some insight of how we’re looking at how we’re interpreting this test. And we put this test together to look at body system three and we have to look at the other two body systems, and maybe even blood work. And obviously, a full diet and lifestyle review so we can get a complete picture of what’s happening under your metabolic.
If you enjoy this video, click subscribe on screen. If you’re a little overwhelmed and you want to dive in deeper to your health challenges, and you want to figure out what’s happening with your unique case, click on screen or click below the consult link. Go to http://justinhealth.com and schedule a consult with myself. Again, this is Dr. J here, look forward to having more great videos coming your way.
My Lab Tests Are Normal But I Still Have Symptoms
By Dr. Justin Marchegiani
I see patients all the time in my practice that tell me they don’t feel right, yet their medical doctor tells them their lab tests are normal. The typical response from the average medical doctor will be something like this: “It’s all in your head. You may benefit from taking an antidepressant.” Or if you’re a woman, it may be blamed on female hormone issues, and the next solution may be to go on a birth control pill to help normalize your cycle.
Intuitively, people know something’s wrong even if their lab tests aren’t totally in the red. The most common response I hear in my practice—
“My lab tests are normal, but I still don’t feel well!”
The problem with this scenario is there are physiological, biochemical, and hormonal explanations for why patients feel the way they do. Conventional medicine typically gives these patients no answers and worst of all, can sometimes make them feel as if they’re making it up.
In the world of functional medicine, we tend to look at things differently than your conventional medical doctor. Most lab tests have originated to include 95% of the population into the normal values. So if your medical doctor tells you your labs look fine, that just means you fit into that 95% category, or two standard deviations away from the mean if you are into statistics.
Anyone that has walked around an airport for just a little bit of time will be able to tell you 95% of the population doesn’t fit into the healthy category. Conventional medicine makes a massive assumption that the absence of disease is health. This is like saying the absence of being poor on the street means you’re rich! I hope my analogies help drive the point home that these assumptions are absurd!
Why the Answers to Symptoms Get Missed by Conventional Lab Testing
As society gets sicker and sicker and sicker, we know the reference ranges get wider, and wider, and wider. So if you are someone that may have been healthy to begin with, and then have a sudden drop in your health, you may still fall within that normal reference range. Thus, being told nothing is wrong.
It’s really not your medical doctor’s fault. Conventional medicine trains physicians to look for pathologies or disease, and this is a good thing. Where this paradigm falls short is when you aren’t sick enough to fall into the category of being diagnosed with a disease. So what do you do next?
Essentially, conventional medicine is saying, “Go home, continue doing what you’re doing, get sicker, and then maybe we’ll be able to diagnose you with something in a few years.” Intuitively, that doesn’t sound right to me. We need to look at things in a more sensitive way so we can pick up this slow and steady breakdown before it becomes a major problem.
Your body is designed to adapt to stress. Maladaptation is the number-one sign that your health is starting to decline. If your body loses the ability to adapt to the various stressors in your life, you will eventually come down with some type of disease. The goal of functional medicine is to figure out where the underlying stressors are coming from. Using specific lab markers that are sensitive, we can chart your overall health function on a spectrum so as we start incorporating treatments, we have objective and subjective markers of improvement.
Functional medicine can look at the exact same labs and potentially pick up subtle things that conventional medicine may not. Click here to get your labs assessed.
Thyroid Lab Testing and the Inadequate TSH Test
Most people have low thyroid symptoms even though their thyroid lab tests are normal! The standard panels that are looked at are typically a TSH test (a brain hormone) and T4 test (a storage thyroid hormone). It always bothers me that conventional doctors very rarely look at the active thyroid hormone (T3) to assess a thyroid problem. Especially since the research over time has shown that TSH testing isn’t the best to assess thyroid function. If TSH is elevated, it’s a surefire sign of thyroid dysfunction, but it’s a marker that tends to elevate late in the game.
Above are the markers that I commonly run on my patients to assess which pattern of thyroid dysfunction they have. Thyroid antibodies are also looked at to assess if there is an autoimmune disease at play. Most conventional physicians totally ignore thyroid antibody testing completely because it doesn’t change the conventional treatment; Synthroid will be given either way. Knowing whether or not a patient has an autoimmune thyroid disease (Hashimoto’s thyroiditis) can make all the difference in the world.
When we are dealing with Hashimoto’s, it’s the immune system that is out of balance. It is destroying the thyroid gland. It doesn’t make sense to put all of our focus on the thyroid gland if the immune system is attacking it daily. Some people with Hashimoto’s (hypothyroidism) may need thyroid hormone depending on how bad the damages is. I always recommend getting a full assessment like the one above before it is recommended. Hashimoto’s patients will typically respond better on a combination of T3 and T4, like in Nature-Throid, or a bioidentical thyroid glandular instead of a synthetic T4 medication.
Assessing the glands that help control and regulate stress is very important to your health. Your body is designed to be healthy, and part of being healthy means adapting to stress. Your adrenals are instrumental at producing hormones throughout the day that are designed to do just that.
Cortisol is secreted in a pulsatile fashion, higher in the morning and then tapering off throughout the day. Cortisol is designed to help stabilize blood sugar and help deal with stress and inflammation. The more dysfunctional our adrenals become, we start progressing into deeper stages of adrenal fatigue. This is where our brain (the master controller) isn’t able to communicate with our adrenals properly and we develop HPA axis dysfunction. This is nothing more than communication breakdown that can be fixed with proper diet, lifestyle, stress management, and a properly prescribed adrenal program (specific to your pattern of adrenal fatigue).
Blood Test Markers for Health
Looking at blood test markers from a CBC, CMP, or lipid panel can provide a pretty good idea of how the body’s systems are functioning.
When we see digestive markers, like albumin, globulin, creatinine, BUN, or serum protein, out of balance, it can tip us off that we may be dealing with some digestive inflammation, low stomach acid, leaky gut, and/or malabsorption.
We can look at markers like RBC, Hgb, Hct, MCV, MCH, MCHC, and ferritin, which are markers for an anemia. An anemia typically deals with deficiencies in certain B vitamins, like folate or B12 and/or iron. Most conventional doctors tend to miss these subtle imbalances. And they can contribute to a person’s inability to transport oxygen, create energy, and convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone).
When we see blood sugar markers, like fasting blood sugar, hemoglobin A1C, or insulin, out of balance, it is a good sign there is inflammation. There are more specific markers that can be looked at, like C-reactive protein, ESR (erythrocyte sedimentation rate), fibrinogen, and a triglyceride-to-HDL ratio greater than 2.
When we assess white blood cell (WBC) function, long-term low WBC can be indicative of a chronic infection, while elevated WBC can be a sign of an acute infection. This rule is the same for the WBC’s constituents as well. Below is a list of the specific components of WBCs. We are looking at the markers below in a more sensitive range than the standard lab range, so we can pick up more subtle infections.
- Neutrophils: Potential bacterial infection including H.pylori
- Lymphocytes: Potential viral infection
- Monocytes: Potential parasitic infection and recovering from an infection
- Eosinophils: More specific for a potential parasite infection
- Basophils: Can increase due to allergies, inflammation, or parasites.
- Alkaline phosphatase: When low, a sign of zinc deficiency, which is a key immune-system nutrient
Most people who are tired and moody and have weight gain and hormone imbalances tend to have an infection! I have tested hundreds of patients, and I would say, based on my experience, over 70% have a parasite, bacteria, or fungal infection.
Yet in First World countries, it still isn’t accepted, by and large, that these infections can cause a problem. But having worked with many patients with these infections and having helped to remove the infections, I can tell you I’ve seen significant changes, and my patients will tell you the same.
These infections can cause classic GI symptoms, like bloating, gas, constipation, diarrhea, and acid reflux. These infections, at the same time, can cause symptoms that are more nuanced, like depression, hormone imbalances, fatigue, neurological issues, skin issues, and weight gain. It’s hard to connect the dots when these infections aren’t causing the typical symptoms you would see in Third World countries (distended bellies and such).
So What Do I Do Next?
If you are told that your lab tests are normal but you know something deeper is wrong, you are probably correct. Most of these problems if left alone only get worse and take more time and money to fix later on.